Fitness Tip: The ADA Lower Your Risk Fact Sheet

You Are In Control
Don’t think your risk level for type 2 diabetes is written in stone. Whether you need to lower your risk level or maintain the low risk you already have, this sheet has the tips to help you take control.

Stay Healthy
When you build exercise into your daily routine, it’s hard to come up with reasons to avoid it. Try these exercise ideas out for yourself:

• Plan breaks away from your desk. Choose specific times of day you can get up and walk around.
• Use the stairs instead of an elevator. If that’s too difficult, try taking the elevator part of the way and the stairs the rest of the way. You can gradually increase the amount of stairs as you improve.
• Choose a parking spot farther away from the entrance to work or any other place you visit. The extra distance will pay off.
• Do you use public transportation? Get off a stop or two early and walk the rest of the way.

Source: Copyright © 2006 American Diabetes Association.| From The “I Hate to Exercise” Book

Feeling Stuffed?
It’s not exactly your fault. Portion sizes have grown in recent years, changing our perception of what’s an appropriate amount of food for one meal. Since you can’t trust the size of your plate, instead use your hand to help measure portion sizes:

• A fist = 1 cup
• Palm of a woman’s hand = 3 ounces
• Palm of a man’s hand = 5 ounces
• Thumb tip = 1 teaspoonThumb = 1 tablespoon

Source: Copyright © 2006 American Diabetes Association. | From What Do I Eat Now?

Ask The Right Questions
Scheduling regular checkups is important for managing your health.
Here are some useful questions to ask your doctor the next time you have an appointment.

• What is the circumference of my waist? (A healthy number is 40 inches or below for men, and under 35 inches for women)
• What is my blood pressure? (Less than 120/80 is ideal)
• Should I be screened for type 2 diabetes? (Maintain a schedule of being tested every 3 years after age 45 and ask your doctor to explain the test results and provide tips on how to lower your numbers if need be)
• What is my cholesterol? (Total cholesterol should be less than 200, with LDL levels less than 100 and HDL levels more than 40 mgs for men, and 50 mgs for women)
• What are some small steps I can take to be healthier and avoid type 2 diabetes?

Source: American Diabetes Association’s CheckUp America campaign

 

Download your own copy of the ADA FACT SHEET

Go HERE for information on the Type 2 Diabetes Program designed by Fitness Together

Donald Whittemore is an FT Type 2 Diabetes Success Story

 

Seniors: Preventing & Managing Diabetes

According to a recent study, 22 percent of senior citizens aged 65 and older have diabetes and nearly 40 percent suffer with a form of pre-diabetes, which becomes more common with age. State Representative Edward F. Coppinger hosted a talk on how Seniors can prevent or manage diabetes. To lead the talk, Representative Coppinger invited Fitness Together’s Steve Lichtman and Al Whitaker, Associate Director Communty Programs for the American Diabetes Association, to this year’s Roslindale Senior Palooza.

Rep Coppinger

American Diabetes Association 

More info on the Type 2 Diabetes Program designed by Fitness Together

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Senior Palooza

1st collector for Senior Palooza on Diabetes 5 20 11
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Structured Exercise Improves Glycemic Control In Diabetics

Newswise Release — Implementing structured exercise training, including aerobic, resistance or both, was associated with a greater reduction in hemoglobin A1c levels (a marker of glucose control) for patients with diabetes compared to patients in the control group, and longer weekly exercise duration was also associated with a greater decrease in these levels, according to results of an analysis of previous studies, published in the May 4 issue of JAMA. (For full article, go HERE.)

“Exercise is a cornerstone of diabetes management, along with dietary and pharmacological interventions. Current guidelines recommend that patients with type 2 diabetes should perform at least 150 minutes per week of moderate-intensity aerobic exercise and should perform resistance exercise 3 times per week,” according to background information in the article. “Regular exercise improves glucose control in diabetes, but the association of different exercise training interventions on glucose control is unclear.”

Daniel Umpierre, M.Sc., of the Hospital de Clinicas de Porto Alegre, Brazil, and colleagues performed a systematic review and meta-analysis of previously conducted randomized controlled clinical trials (RCTs) of at least 12 weeks’ duration that evaluated the ability of structured exercise training or physical activity advice to lower hemoglobin A1c (HbA1c) levels as compared with a control group in patients with type 2 diabetes. The researchers identified 47 RCTs (8,538 patients) that met criteria for inclusion.

The researchers found that overall, structured exercise training (23 studies) was associated with a decline in HbA1c level (-0.67 percent) compared with control participants. In addition, structured aerobic exercise (-0.73 percent), structured resistance training (-0.57 percent), and both combined (-0.51 percent) were each associated with declines in HbA1c levels compared with control participants.

“Structured exercise durations of more than 150 minutes per week were associated with HbA1c reductions of 0.89 percent, while structured exercise durations of 150 minutes or less per week were associated with HbA1c reductions of 0.36 percent. Overall, interventions of physical activity advice (24 studies) were associated with lower HbA1c levels (-0.43 percent) compared with control participants. Combined physical activity advice and dietary advice was associated with decreased HbA1c (-0.58 percent) as compared with control participants. Physical activity advice alone was not associated with HbA1c changes,” the authors write.

“This systematic review and meta-analysis of RCTs demonstrates important findings regarding the prescription of structured exercise training. First, aerobic, resistance, and combined training are each associated with HbA1c decreases, and the magnitude of this reduction is similar across the 3 exercise modalities. … Second, our findings demonstrate that structured exercise of more than 150 minutes per week is associated with greater declines in HbA1c than structured exercise of 150 minutes or less per week in patients with type 2 diabetes. This finding is important because the current guideline-recommended exercise duration is at least 150 minutes per week. Although high-intensity exercise has been previously shown to have an association with HbA1c reduction, our findings did not demonstrate that more intensive exercise was associated with greater declines in HbA1c.”

The researchers add that the finding that physical activity advice is only associated with HbA1c reduction when accompanied by a dietary cointervention highlights the need for a combined recommendation of these lifestyle interventions.

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

_____________________

Go HERE for more information on the Fitness Together Type 2 Diabetes Program.

A Type 2 Diabetes Success Story: Donald Whittemore

More Success Stories at FTGetsResults.com

American Diabetes Association: Step Out For A Cure

Vimeo video by by Mark Helman

Fitness Together is a proud sponsor of the American Diabetes Association and their Step Out Walk To Stop Diabetes. Last year, the Fitness Together Massachusetts Owners Group, specializing in one-on-one personal training, raised more than $50,000 for the American Diabetes Association of Eastern New England.

Our network of 43 Fitness Together franchised studios throughout Massachusetts, Rhode Island and New Hampshire collectively signed on as the Official Health and Fitness Sponsor for the ADA’s STEP OUT: Walk to Fight Diabetes campaign to raise the funds and make the contribution. 

Meanwhile, the additional sweat they have put into helping people living with type 2 diabetes across their fitness studios has magnified their cause and given a face…several faces… to the illness.

Separate from the crowds at STEP OUT walks in Worcester, Mass.; Providence, R.I.; and Boston, Fitness Together certified personal trainers have spent many months up close and personal with people battling the illness, who are on a quest for health and wellness.

“A lot of people can raise money, support a good cause, and call it a day. But that’s not what Fitness Together had in mind when we signed up to support the ADA chapter,” said Steve Lichtman, owner of 4 Fitness Together franchises. “We also wanted to invite people living with type 2 diabetes into our studios to offer personal, tailored and safe exercise and nutrition guidance that could improve their lives for the better.”

In conjunction with the fundraising effort that surpassed Fitness Together’s goal to raise $40,000 for the ADA, the group enlisted 35 people with type 2 diabetes across Eastern New England for their type 2 diabetes observational study. Fitness Together tracked the impact of a fitness and nutrition program on their client’s type 2 diabetes over a six month period. The results have been amazing.

“We have seen dramatic transformations both physically and emotionally,” Steve said. “This isn’t just about losing weight. It’s about battling an illness in a smart, responsible and healthy manner.”

And the battle continues. Based on the success of this study, Fitness Together wants to broaden the awareness of it services.

People with type 2 diabetes are encouraged to contact their local Fitness Together studio and visit FTGetsResults.com to get more information. “The positive impact of helping people lose weight, get in shape, lower their dependence on medications and live a more fulfilling life is the best motivator,” said Chris Boynton, Executive Director for the ADA, Eastern New England

To view success stories from our other FT clients go to FTGetsResults.com

Diabetes Diet: Vinegar Never Tasted So Sweet

by Sarah Robertson, RD, CDN for FYI Living

Approximately 23.6 million Americans have diabetes. That means a staggering 7.8 percent of the U.S. population currently suffers from diabetes. We know that proper diet and regular exercise are fundamental in order to achieve desirable glucose (or blood sugar) levels. But could certain foods we’re eating actually help lower blood sugar? Some research says yes. Cinnamon, chromium, and vinegar have all been under investigation for their potential ability to help improve glycemic control in people with diabetes.

Cinnamon

Diabetes (type 2) is characterized by a decreased sensitivity to insulin. Insulin is the hormone that gets sugar into our cells so that it can be used for energy. Researchers have found that cinnamon may increase insulin sensitivity. Studies show that cinnamon can decrease fasting blood sugar by 10 to 30 percent depending on the dose. Cinnamon may also improve cholesterol levels in diabetics according to small research studies.

• The bottom line: A dose of one to three grams of cinnamon per day is a safe dietary intervention that may help achieve improved glycemic control in people living with type 2 diabetes. To realistically get a dose this large, however, you’d probably need to take your cinnamon in capsule form.

Chromium

When we eat carbohydrates, blood sugar levels increase in the blood stream. Chromium, a mineral that’s needed in the body in trace amounts, appears to be directly involved with carbohydrate metabolism by playing a role in insulin sensitivity. The majority of research has shown that dietary supplementation of chromium is beneficial in moderating glucose levels by improving the insulin response. It may also have a positive impact on cholesterol levels.

• The bottom line: The AI (adequate intake) is 35 mcg for males and 25 mcg for females. The most effective forms of chromium supplementation in the studies were brewer’s yeast, chromium picolinate and chromium chloride. Food sources of chromium include broccoli, grape juice and red wine. That said, chromium supplementation may help improve blood sugar control in diabetics, though it is not completely clear what an effective dose is.

Vinegar

Accumulating evidence indicates that vinegar may mitigate blood sugar levels following a carbohydrate-rich meal. Vinegar contains acetic acid, which may slow gastric emptying. This is especially important for diabetics because a delay in gastric emptying means a slower, more gradual absorption of nutrients, which makes for a more gradual rise of blood sugar in the bloodstream. Additionally, acetic acid may block the complete digestion of starch molecules, and promote glucose uptake by muscles. Theoretically, if vinegar can reduce post-meal sugar levels, it would help improve longer-term blood sugar control in diabetics.

• The bottom line: Regular vinegar used modestly appears to improve glycemic control. Vinegar can easily be incorporated as a complementary means to reduce hyperglycemia, but should not replace ongoing adherence to a moderate carbohydrate diabetic diet and use of prescribed diabetes medications.

Many of the studies that examined the effectiveness of these interventions were small, and the research is still at an early stage. Nonetheless, this is valuable information. Adding some cinnamon, supplementing with chromium and incorporating more vinegar into your diet are all simple and safe ways to potentially improve glycemic control in diabetics. It is important to note that these interventions are recommended as ancillary treatments. These foods or nutrients are not a replacement for a carbohydrate controlled/diabetic diet, regular exercise, oral hypoglycemic medications or insulin.

Read more at FYI Living

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Not Dead Yet: Team Type 1 Phil Southerland’s Book

My Race Against Disease: From Diagnosis to Dominance

By Phil Southerland and John Hanc

Part memoir, part sports adventure, Not Dead Yet tells the inspirational story of Phil Southerland’s battle with Type 1 diabetes and how from diagnosis to sheer determination, Phil Southerland beat all odds and turned his diagnosis and his passion for cycling into a platform. From leading a Race Across America to now managing a world-class cycling program, his journey on and off the bike is changing the way the world views diabetes.

When Phil Southerland was seven-months-old, he lost ten pounds in a week, his body was limp and his breathing slowed to what his mother called a “death rattle.” Rushing him to the ER, she was informed that tiny Phil displayed the youngest case of diabetes on record in the world at that time. Blindness, kidney failure and death were all predicted for him by age twenty-five.

Twenty-nine years later, not only is Phil alive and well but as the founder of Team Type 1, he and his team of championship cyclists — many of them diabetics—have become health and fitness role models for people the world over. Together, they have taken on some of the most challenging endurance events in the world, including winning the Race Across America—a grueling 3,000-mile endurance competition—twice.

Today, Phil continues to lead Team Type 1 as its professional cycling team, among one of the top 30 teams in the world, races toward an invite to the world’s top cycling event, the Tour de France in 2012.Leading the pack is a serious challenge for any athlete, but for Phil and his teammates, it presents two daily battles: one to stay in razor-sharp race-fit condition, the other, to stay alive.

Not Dead Yet is Phil’s powerful story: his account of his relationship with his mother, and how she struggled to keep him alive; growing up quickly in the New-Old South of the 1990s, learning at the tender age of 6 years old how to check his glucose and give himself injections; of how he fulfilled his dream of becoming a professional athlete using his team and the bike as a platform, inspiring thousands of individuals and families around the world who are battling diabetes to not just chase, but catch, their dreams.

PHIL SOUTHERLAND is the founder of Team Type 1, a team of championship bike racers. He and Team Type 1 have been profiled in numerous cycling and diabetes publications, the New York Times, the Washington Post, the Wall Street Journal, and the Atlanta Journal Constitution. He lives in Atlanta, where Team Type 1 is based. Visit him online at http://www.teamtype1.org.

JOHN HANC teaches writing and journalism at the New York Institute of Technology. He is a long time contributor to Newsday and a contributing editor to Runner’s World magazine, as well as the author of The Coolest Race on Earth. He lives with his wife and son in Farmingdale, New York.

“This book is a must read for all of us with type 1 diabetes and for our support team of family and friends as well. Phil Southerland’s account of his battle with diabetes and triumph over it seeks to and succeeds at being an educational and inspirational guide for reaching the full potential that exists in all of us.” – Show business legend and New York Times bestselling author of Growing Up Again Mary Tyler Moore

“Not Dead Yet is an uplifting and incredibly true adventure of a young man who beats the odds. Phil Southerland is an inspiration to those who live and struggle with diabetes as well as any individual who faces seemingly insurmountable challenges.” –Steve Edelman, MD, University of California-San Diego, Founder and Director of Taking Control of Your Diabetes

Read Chapters 1 & 2 of Not Dead Yet

For more on Team Type 1 and the book.

More Success Stories from Team Type 1

Diabetes Daily Dish: Osso Bucco

This is a fabulous winter dish, great for this time of the year, right on the cusp of spring when the air is crisp. It’s warm, filling, and festive. You can serve it with pasta, risotto, polenta, or on it’s own with a salad. Don’t forget about the marrow in the shank. That’s the best part! Eat it with a piece of whole grain bread, if you can.

• 1 1/2 cups all-purpose flour
• 4 veal shanks, about 2″ thick each
• 2 teaspoons olive oil
• 2 large onions, sliced
• 6 Roma tomatoes, finely chopped
• 2 Tablespoons tomato paste
• 1 1/2 cups white wine
• 1 Tablespoon cornstarch
• 3 garlic cloves, crushed
• 1/2 cup parsley, chopped

Gremolata

• 1 Tablespoon lemon zest
• 2 garlic cloves, minced
• 3 Tablespoons parsley, chopped

Make the gremolata first, by mixing together the lemon zest, the garlic and the parsley. Set aside.

Combine the flour with salt and freshly ground black pepper in a bowl. Toss the veal shanks in the flour mixture and shake off any excess.

Heat 1 Tablespoon of the olive oil in a cast iron skillet over medium-high heat. When the oil is hot, brown the veal on both sides. Remove from the pan, and set aside.

Heat the remaining 1 Tablespoon of oil in the same skillet and cook the onion for about 2-3 minutes over medium heat, until tender. Add the veal back in and season to taste with salt and freshly ground black pepper.

Mix together the tomatoes, tomato paste and wine and pour the mixture over the meat. Bring to a boil, then reduce the heat, cover, and cook for 1 1/2 hours.

Remove about 1 cup of the cooking liquid from the pan and set aside to cool. Put the cornstarch in a small bowl and mix in the cooled cooking liquid. Stir in the garlic, chopped parsley and add back to the pan. Simmer, uncovered, for about 30 minutes, or the meat is very tender and the sauce has thickened. Top with gremolata just before serving.

NutriFacts
Servings: 4

Amount per Serving
Calories: 500
Carbohydrates: 21g
Dietary Fiber: 3g
Sugars: 7g
Fat: 12g
Saturated: 3g
Trans: 0g
Sodium: 313mg
Protein: 69g

Diabetes Daily

For more on Fitness Together’s Type 2 Diabetes Program

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Effect of Exercise on Diabetes

As posted in US Medicine (The Voice of Federal Medicine)

BETHESDA, MD—For years now, physicians have been imploring the nation to get more exercise. Pointing to research showing great benefits in overall health and in combating chronic disease, researchers have also been pressing employers to include exercise and nutrition programs into the workplace. The theory is that an exercising workforce is a healthier, happier, and more productive workforce. Also, with the cost of insurance rising due to the need to treat chronic diseases, a healthier workforce is a less expensive one.

Employees as Research Subjects

In 2004, NHLBI undertook a commitment to put its research where its mouth is, establishing a worksite wellness program called Keep-the-Beat. The program encouraged heart-healthy behaviors, and included physical and nutrition activities for all NHLBI employees. Physical activity rooms were installed in several NIH buildings, and interested employees were given pedometers. Health stations were set up where employees could measure their blood pressure and weigh themselves.

The following year, a fellow working at NHLBI took note of the program and suggested opening a research protocol to measure the effects of the program on vascular disease.

“At the time the protocol’s primary focus was on the endothelium,” explained Dr Richard Cannon, NHLBI clinical director at an NIH symposium on diabetes and heart health last month. “[The focus was] on the idea that participation in the program could mobilize bone-marrow derived cells—called endothelial progenitor cells.”

Researchers believed those cells would be pushed out of the bone marrow into the blood stream and attach themselves to diseased or damaged endothelium, helping repair it.

“What we learned was that sedentary employees of the clinical center entering the Keep-the-Beat program were overweight or obese [with] many cardiovascular risk factors,” Cannon explained.

The study showed a reduction in blood pressure, as well as in total LDL and HDL cholesterol. “We did see increased EPCs, but only a small contribution to improved endothelial function.”

Examining Insulin Resistance

Believing studying employees in the program might yield even more data, Cannon and his colleagues wrote a second protocol. This one looked at other vascular functions that might be improved by the program, including changes in insulin sensitivity, high-density lipoprotein function and adipokines—cell-to-cell signaling proteins secreted by adipose tissue, or body fat—in overweight and obese women. This time, they looked specifically at women in the program, recruiting 200 women for six months of exercise training, nutritional counseling, and caloric reduction.

“How exercise interacts with insulin is not entirely clear, but there’s clearly an interaction between the two,” Cannon noted. “There’s some controversy in the field. Is it fatness, or fitness, or lack thereof [that determines outcome]? Some people think you can be fat and fit, and it’s just as good as being not fat. A lot of epidemiologists have looked at this over the years and shown that fitness does matter. Most of the trials are in men [and most show] that fit people do better over time.”

Preliminary data from 100 of the participants—a mix of black and white employees—has shown a significant relationship between BMI and insulin sensitivity. The two have an inverse relationship, with the higher BMI leading to lower insulin sensitivity. “Most of our participants are below the [insulin resistant line], with about 25% in the insulin resistant range,” Cannon explained. “BMI was a predictor of diminished insulin sensitivity.”

Researchers also found that there was a racial difference in what body types were the best predictors of diminished insulin sensitivity. For blacks, waist circumference was a strong predictor, while truncal fat was the strongest predictor for whites.

“Skeletal muscle may be less effective in oxygen consumption during exercise and less insulin sensitive in blacks compared with whites, contributing to poor fitness and insulin resistance, respectively, in black women,” Cannon noted.

The study also found that poor fitness plays an even larger role in non-insulin dependent glucose uptake in blacks and whites.

Currently the participants are set to enter the activity phase of the study, which involves 30 minutes of activity on most days, with caloric decrease and expected weight loss. Researchers will then examine whether these changes will have a demonstrable effect on patients’ health.

Asked why death by CV disease is decreasing in the face of the obesity and diabetes epidemic, Cannon predicted that the steady decrease the nation has experienced over the last few decades might be coming to an end. “That decrease is probably from better control of blood pressure, statins to control cholesterol, judicious use of revascularization and surgical heart treatments, and better drugs for treating acute coronary syndromes,” he explained. “But obesity is clearly working against this. I read editorials that speculate that now we’ll see an uptick in CV disease and that our children will not live as long as we are going to live, as they become more obesity and diabetes prone.”

US Medicine

Exercise is Medicine!

from HOPE WARSHAW, RD, CDE who was attending the Food and Nutrition Expo of the American Dietetic Assoc.

Exercise is Medicine! Understanding the Evidence and Initiating the Client Conversation: Prior to this session, I was unaware of the Exercise is Medicine initiative of the American College of Sports Medicine and American Medical Association. Robert Sallis, MD, Chair of the Exercise is Medicine Task Force, kicked off the program giving us our marching orders: nutrition professionals MUST integrate exercise advice and encouragement into our counseling.

He noted, “physical inactivity has an astonishing array of harmful health effects and that physical inactivity is THE major public health problem of our time.” As we know with prediabetes and type 2, exercise is a powerful prevention and treatment tool. Relevant to many people at risk for and with T2, low level of fitness is a bigger risk factor for mortality than mild to moderate obesity. Sallis noted that the benefits of physical activity are the same regardless of weight status.

The litany of mental and physical health benefits are well known to us all. Exercise is Medicine promotes several concepts:

1. assess and discuss exercise with every patient, every visit and make it part of every treatment plan,
2. record exercise as a vital sign
3. provide consistent message across providers.

Joan Hill, RD, CDE, LDN

Consultant to the Diabetes Prevention & Control Program
Massachusetts Department of Public Health
250 Washington Street, 4th Floor
Boston, MA 02108

Fitness Together has created a program specifically for Type 2 Diabetics.

To view videos on our Type 2 Diabetes Study and Program, go here.

For more information on the study and program go here.

Last-Minute Gift Ideas for the Diabetic Cook

Christmas is literally right around the corner and if you’re in need of an idea or two as to what to get that special person, here’s some ideas from the Diabetic Lifestyle site.

Here’s ten nifty suggestions for someone  who has diabetes and does the cooking, or is the person responsible for preparing diabetic meals for someone else, or just someone trying to stay on a trim and fit diet.

1. A digital roasting thermometer with preset temperatures for 15 different kinds of meat or poultry that alert you when the item is done (or nearly done).
2. A food processor that chops, slices, shreds, and purees, making these time-consuming preparation tasks quick and easy.
3. A nickel-plated steel cookbook holder with an acrylic splash guard that keeps cookbooks neatly displayed at your preferred reading angle while you’re cooking.
4. A stainless steel rolling mincer for chopping a handful of fresh herbs or a clove of garlic.
5. An electronic food scale for weighing foods. Some models are pre-programmed to give you nutritional values for more than 1,000 foods, and keeps running totals over a period of time for tracking calories, fat grams, carbs, and more.
6. A fat separator for sauces and gravy that separates the fat from the pan juices in seconds.
7. Tupperware food storage containers, seasoning blends, and knife sets. Many containers go from freezer to microwave for cooking and then to the table for serving. Order from our Diabetic Supply Store.
8. Silicone spatulas that won’t crack, chip, or lose their shape while withstanding temperatures up to 450°F. Great for making omelets and scrambled eggs.
9. A programmable crockpot that allows you to cook delicious meals (without additional fat) while you’re away from home.
10. One of our cookbooks from our Book Store: The Joslin Diabetes Great Chefs Cook Healthy (delicious diabetic recipes from some of the best chefs in the world), The Joslin Diabetes Healthy Carbohydrate Cookbook (more than 200 fabulous ways to cook foods with carbohydrate and no animal protein), The Joslin Quick and Easy Cookbook (more than 200 yummy recipes for breakfast, lunch, and dinner-mostly for two servings), and The Joslin Diabetes Gourmet Cookbook (more than 500 outstanding recipes for family and friends).

Merry Christmas!

Diabetic Lifestyle